820556_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

E 31111111111111L,
Fac't�y Number -
Type of Visit: om lienee inspection
Reason for Visit: Owcoutine Q Compla;
:w U Structure Evaluation Q Technical Assistance
O Referral Q Emeriency O Other Q Denied Access
Date of Visit: 1I Arrival Time: '10 F Departure Time: Fp U County: �— Region: ba�
Farm Name: et Owner Email:
Owner Name: 1 4a a klcy p Wa,-i Phone: .
Mailing Address:
Physical Address:
Facility Contact: f ( Title: Phone:
Onsite Representative: t 1
Certified Operator: W' 1 ma k'100iayawt,
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:Cf
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No E] -KA
/ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [3 -NA []NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ NoA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E"NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued
Design Current
Design,
Current
Design Current
Swine
Cpty Fop.
Wet Poultry] I`
Cpa
Pop.
Cattle Capacity Pop.
V. ,,
Wean to Finish
i aver
Dai Cow O
Wean to Feeder
Non -Laver
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
"I6
Design
Carrent
D Cow
Farrow to Feeder
Dry Pou It . .
; ,Ca act
P,a P.
Non-DaiTy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
OthME
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No E] -KA
/ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [3 -NA []NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ NoA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E"NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili umber: jDate of Inspection. -,7
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ale --B NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 3 1( T�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [�o ❑ NA ❑ NE
❑ Yes [D -No'❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑-16 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [] "-b O NA ❑ NE
maintenance or improvement?
Waste Application �-,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes Yes No 0 NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C5'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop [W�indow ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): C� c) L(a4"P tt,-Iq. S &-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
R uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes �o
❑ Yes E:rNo
❑ Yes p-1vo
❑ Yes J2 -No
❑ Yes �o
❑ Yes ❑'<o
❑ Yes <o
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D ""
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P]1�0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2015 Continued

Facifi umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED -Mb ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [3<o ❑ NA [3 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O'l�lo
❑ NA
❑ NE
❑ Yes
❑. 56
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3 -No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
Efl-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®`No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
340
❑ NA
❑ NE
Cornifiejhts!(Fiffif,to
, x0 ytE"d/ra eii1M1F6bns orgnY other
Uwkgdk ffacilty to Netter pages sncssry
comments. V
-CA(
KV
Reviewer/Inspector Name: k3 $ 2 (4-4-4 Phone.gtd 3 �3 J�
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

Di'visi n of Water Resources y
Facility Number - Division ofESoil andWater Conservation
Q Other Agency -
ype of Visit:zoutine.
liance inspection Operation Review O Structure Evaluation O Technical Assistance
eason far Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: LJl11J� 4 tl Arrival Time: Departure Time: . Q County: C4:5E Region
Farm Name: 10,0 1 Owner Email:
Owner Name: (l (a AIJL1411& / Phone:
Mailing Address:
Physical Address:
Facility Contact.- �Gc.ti j ��oitrt Title: Phone:
A
Onsite Representative: "i ( Integrator:,! _
Certified Operator: Certification Number:��
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes. notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [c�o ❑ NA ❑ NE
❑ Yes [] No e'RA ❑ NE
❑ Yes [:]No 2 -MA ❑ NE
❑ Yes
-Designer Current
[�rNA
Design Current
Design Current
$wipe Capacity Pop.
Wet Poultry, CE aci Pop -
Cattle
Capacity Pop.
ONo
❑ NA
❑ NE
Wean to Finish
La er
Nott -La er
-
Dai CowD
Dai Calf
Dai Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
.'
DesrgnCurrerit
D Cow
Farrow to f=eeder
l . C'a- aci
Non -Dairy
Farrow to Finish
Layers
rNon-Layers
Beef Stocker
Gilts
Beef Feeder
Boars
THurks S_-;
Beef Brood Cow
'
Clther
Turks Poults
Other
m•
Other
Dischar es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes. notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [c�o ❑ NA ❑ NE
❑ Yes [] No e'RA ❑ NE
❑ Yes [:]No 2 -MA ❑ NE
❑ Yes
❑ No
[�rNA
❑ NE
❑ Yes
[ 17No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

1
a
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No C],4-eA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z`No
❑ NA
Spillway?:
13. Soil Type(s): p ,
Designed Freeboard (in):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
Observed Freeboard (in):
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
Efl—No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes[INo
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
acres determination?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
e N
[] NA
❑ NE
waste management or closure plan?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ff'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ERIN'o
❑ NA
❑ NE
maintenance or improvement'?.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes 2"N. ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S
..t rs-
0 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z`No
❑ NA
❑ NE
13. Soil Type(s): p ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
Efl—No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
La"No
❑ NA
❑ NE
acres determination?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
17. Does the facility lack adequate acreage for land application?
❑ Yes
F21�o
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z`No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ pease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�-No
❑ NA
EINE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

i
Facili Number: Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U3'<0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0N0
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question ft Explain any. YE&answers.,siic
Reviewer/Inspector Name: % ��
Reviewer/Inspector Signature:
Page 3 of 3
additional recommendai
es. as necessary).
❑ �--
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
❑ Yes
NA
❑ NE
❑ Yes
g3 No
❑ NA
❑ NE
❑ Yes
EEfNo
❑ NA
❑ NE
❑ Yes
E:fNo
❑ NA
❑ NE
❑ Yes dNo
❑ Yes dNo
❑ Yes Ef No
I -)z
Ar - A9
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Phone: g J 3` JFt_ Date:
2/412015

Type of Visit: (Y -Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: GMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: ' t] County: _ Region:, j- r
,f
Owner Email:
Owner Name: [�Q �j4 �� b,/�Gf Phone:
Mailing Address:
Physical Address:
Facility Contact: I _(pi),,p W_G-✓!7 Title: Phone:
-�
Onsite Representative: Integrator: 97`
Certified Operator: Certification Number: r ? DO
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop. Wet Poultry
Design
Capacity
Current
Pop.
Design Gurrent
Cattle Capacity Pop.
WNo
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
-I
JNon-Layer
I
Dairy Calf
Feeder to Finish
'^r-.-
y f -
'Dr , 1?oult
Design
Ca aci
Current
P,o ,
Dairy Heifer
- Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
Other
_
Dischar es and Stream Im acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EG.Ptff— ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑ No
[:]Yes
❑No
❑ Yes
214,
❑ Yes
WNo
EjLflA ❑ NE
Q+IA ❑ NE
[;3 -NA
❑ NE
NA
❑ NE
❑NA
❑NE
Page I of 3 2/4/2014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g -W ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No O<A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes ER'110 ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes To ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes GD.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0-15%
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9. Does any part of the waste management system other than the waste structures
require [] Yes eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
❑ Yes
[2*'No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Q�o
❑ NA
r] NE
maintenance or improvement?
❑ NE
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [.'1To
❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Rf No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KfrNo
❑ NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�3 No
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2*'No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,-;i No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LO No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check
❑ Yes
[7No
[INA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
[:]Yes
[� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
6 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
15 No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Faci

I ype of visit: (9 -Compliance Inspection U Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: Cr�outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ;OJ Departure Time:i U� County:
Farm Name: rIIO bet- �a, T AG � Owner Email:
Owner Name: ! o 1 hktk �Do +Mb "1 Phone:
Mailing Address:
Physical Address:
Region: r_62
Facility Contact: KEW�pa,,t�, Title: QCr�� Phone:
Onsite Representative: O x t Integrator: / V P _
Certified Operator: (,J vt� ^
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: [ (0 K 7 Z
Certification Number:
Longitude:
Design Current11@
11 1110
Design
Current
Design Current
Swine Capacity Pop.
Wet 1?�aultry..
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow C4 b
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
„' '°'
i;"
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D : il',oul
Ca aci
Pio ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance rnan-made?
b. Didrthe discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes Uf No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:)No ❑/NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 12'&6 ❑ NA ❑ NE
O
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [!:rNo ❑ NA [] NE
of the State other than from a discharge?
Page I of 3 () 21412011 Continued
10
[]Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
E3 -14A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:)No ❑/NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 12'&6 ❑ NA ❑ NE
O
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [!:rNo ❑ NA [] NE
of the State other than from a discharge?
Page I of 3 () 21412011 Continued

Facility Number: jDate of Inspection:h9 T'n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No i__I fqA— ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ 4o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ I<oo D NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3'NO ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LDo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
KO ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window // [] Evidence of
4Wind Drift
❑ Application
pplication Outside of Approved Area
12. Crop Type(s): C-0✓�`C41t_/fpor.,,It' �"i4.Qt_
13. Soil Type(s): s C9 o d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [B<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [KJ-I�o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [aXo ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [5,1140 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [` No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] [;No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

ia*
Facili Nu er: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®moo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea -Ko- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes / No ❑ NA ❑ NE
❑ Yes [04o'_ ❑ NA ❑ NE
❑ Yes ['No ❑ NA ❑ NE
❑ Yes [[J No ❑ NA ❑ NE
❑ Yes dNo
[-]Yes YNo
[:]Yes [3No
❑NA ❑NE
0 N 0 N
[DNA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other commen&.
Use drawingstUfacility to better explain situations (use additional pages as necessary). i2 � 1
Reviewer/Inspector Name: '16 1
Reviewer/Inspector Signature: C
Page 3 of 3
Phone: q3 3 —
Date: X1 "` r
214120,11

fsAS &
Type of Visit: C) Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: CountysJ�y Regio
Farm Name:
Owner Name:
L
Mailing Address:
Physical Address:
Facility Contact: xW I
lc `
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Cl Owner Email:
Phone:
Phone:
Integrator:
Certification Number:���
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
h
Design §Murrent
Desi nCurrent :
Design Carrent
❑ Yes
Swine
@ap cE'ty s P p -
Wet Poultry Capacty p
Cattle Capacity Pop.
Weto Finish
a. Was the conveyance man-made?
La erDai
Cow
E. NE
Wean to Feeder
Feeder to Finish�w
❑
Non -La er
Dairy Calf
Dai Heifer
Wh
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P,oultry Ca aci ` _ 1?0" .
Non -Da
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
=
Turkeys
Other
Turkey Poults
OthIF er
Other
Discharges and Stream Impacts
h
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NoN
E. NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑
❑ No
;NAYes ❑ NE
Wh
C. at is t e esttmated volume that reached waters of the State (gallons).
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ca No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facilityk6 It,
Number: - Date of Inspection:
W ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes�❑ NA NE
a. If yes, is waste level into the structural freeboard? [-]Yes No L.l NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity ���of any of the the structures observed? ❑ Yes OD P)� ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
(I'� I�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EJAo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [Z/No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
it _ ff — - t_� / 'n 1
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in`f6e CAWMP?
15_ Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
QNo
❑ NA
❑ NA
jr-N-o
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes a[ -Ko- ❑ NA ❑ NE
❑ Yes ®'IQo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [2-114-o ❑ NA ❑ NE -
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LI -90
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and P Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rNoAr
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 1/4/1011 Continued

AQ =MW 41
Facifi Number: - Date of—Inspection:
24r Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LCL'bkr ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes A ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 13<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o ❑ NA ❑ NE
[—]Yes fo ❑ NA ❑ NE
❑ Yes V No [DNA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes u
[:]Yes Wo
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to -question #): Explain any YES answers and/or any additional recommendations or any other�comments
rte_
Use drawings"of fa4ltty to better explain situations (use additional pages as necessary).
cJax�w
6 0 O VfCO KPS , �CGf F --W V^,
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
214/2011

Lype of visit: Qq Compliance Inspection V operation Review V Structure Evaluation I eclinical Assistance
Reason for Visit: 10 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: y�Arrival Time: ! j Departure Time: County: S, yl,[Ch Region: F RQ
Farm Name: Kon �& 00 N Owner Email:
Owner Name: Kr, nb UQ F'N 1 _1 - C, Phone:
Mailing Address:
Physical Address:
Facility Contact -W160- WDUMbn Title: a--0PV -F/- Phone:
Onsite Representative: wl I mi a, Integrator: 1))6L -
Certified
)6L.
Certified Operator:W� 1 yn,,_ kpCrfi Gn Certification Number: R o 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.. Design CurremtDesign
Swine' Capacity Pop. Wet Poultry
Wean to Finish La er
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop-
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Non -Layer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, Poul
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish Layers
Gilts Non -Layers
Boars
Pullets
Beef Brood Cow
-
()cher
Turkeys
Turkey Poults
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued

Facility Number: S 5-(p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 9
Observed Freeboard (in): � 3 T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �@ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [53 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes -P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
[J NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5j No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
CR No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
® NA ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: - wv.SI jDate of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No R NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond 0 Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes f�] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
U No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
® No
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
RNo
❑ NA
❑ NE
Comments (refer,to question ft Explain any YES answers and/or any additional recommendationstor any other comments:
Use drawings of facility to better explain situations (use-'addttional_pages as necessary).
Cows were �e.14 off- cteO
A I ofof ccr fie har bar) foa4 sg/ cve 19.0- a'- roll 4rQai 4 m'fe f I ej j old- CIO
cl
J
wey
c �J r-e(ordr and -(�.elds .
Reviewer/Inspector Name: r Phone: t +0 — 3ITEI )
Reviewer/inspector Signature: Date: V
Page 3 of 3 V4/2011

Facility No: Farm Name 1111-3 1 L3 Date Vwki voiyv
Permit COC _�- OIC_ NPDES (Rainbreake PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway 1 2 3 4 5
6
7
Design Freeboard 1 Last Recorded in
Wettable Acres ✓
RAIN GAUGE
Observed freeboard
WUP ^
Dead box or incinerator
Sludge Survey Date
Weekly Freeboard ✓
Mortality Records
_
Sludge Depth ft
1 in Inspections ✓
Check Lists
Liquid Trt. Zone ft
120 min Insp.
Storm Water
Ratio Sludge to Treatment Volume if> 0.45
Weather Codes
Date out of compliance/ POA?
NBU.".., k,1�r!rqq
Actual Flow
Actual ..
Soil Test Date
Crop Yield ✓
Transfer Sheets
pH Fields
Wettable Acres ✓
RAIN GAUGE
_—J�Cak
Lime Needed M y>1Q7oZ)
WUP ^
Dead box or incinerator
Lime Applied
Weekly Freeboard ✓
Mortality Records
_
Cu -1 Zn -1
1 in Inspections ✓
Check Lists
Needs S (S -I<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
F�>, I;n -
Frnr6.� �r_ d 3t'
Pull/Field
Soil Crop Acres PAN Window Max Rate Max Amt
23S
-I
VII 7a
F 1 I F3
u
t9l-
at Verify PHONE NUMBERS and affiliations W-Pocw ` jbo
�{ Date last WUP FRO 10IN1ji FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump X,A
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac �, -?
S► ICS,• CtIn - IT

. ype ull visit: %a t-ompnance inspection v Lpperanon xevtew V btrucrure jt�vatuanon V t ecnntcat Assistance
Reason for Visit: 1"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: h Departure Time: :Qp County: SQ�yyQSQ^t Region: Fko
Farm Name:K �Q Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address: N5 Tew W Poje o
Facility Contact: W
r r I Title: CO -0 Wr Phone: 7ML &�S(O+D
t
Onsite Representative: v 4 Integrator: p
Certified Operator: �I tn7e� 1� 00101& rl Certification Number: AWR T?OVA
Bach -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes
Design Current
.
^Design
Current
[:]No
Design Current
C] NE
Swine ` Capacity Pop.
. ,
WetP ultry-
'Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
La er
Cow
�$
Wean to Feeder
Non -La er
ADairy
Dairy Calf
Feeder to Finish,;
-"
"'
Dairy Heifer
Farrow to Wean
#
Design
Current
Da Cow
Farrow to Feeder
Farrow to Finish
D Poult
La ers
Ca aci
P.o P.
Non -Dairy
Beef Stocker
Gilts
Boars
-Layers
Pullets
Beef Feeder
Beef Brood Cow
Nil -_
Turkeys
.. ..
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes
[:]No
[:]NA
❑ NE
[3 Yes
[:]No
E:] NA
C] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes H No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J;� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ITC] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [_] Application
Outside of Approved Area
12. Crop Type(s): Slmih'.M _ S o f` CO"ll
13. Soil Type(s): 1�_a��l s Ct�cv i jjTC��a(s�cJ-o
_
,fit
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tg No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Nf No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists F] Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[y No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[$ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
Fr
❑ Iv>✓
Page 2 of 3
2/412011 Continued

Facility Number: S2K jDate of Inspection: 10
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ER NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [5;�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes [] No aNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emcrgency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes allo ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes 'F>Cj No ❑ NA ❑ NE
❑ Yes �'No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
E>_3 No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
RNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
RNo
❑ NA
❑ NE
Comments refer to question ft Explain any YES answers and/or any additional recommendations or any other comments ' F
Use drawings of facility to;better explain situations (use additioaal pages as necessary)..
NAe, jp,.,mvJ owe, hod ei - when-el,er ;fig s C faje`M rect 11111re�
tel Ad
lel i mo, r�� da/ r�car
r ' 9 ' - R('Sh Wye -41 l OeI �4
Melds o�� srr� ��ar� ►� � . �a+a �s ��a�-lO � � 9
Scr911�..�, wr �! be rPvdr� har��f in Q ��- ►��,
lo --Of c lue4e—1opf I'lT t o, .-mnrfj a- pad ma- bar . �4 b►
r
beim i's bevy o�4 Cvr DSO n7anlre pt fes, Lp d hal bEpl) opoielk,vfa'r �
aair rncre S H
p �9 �9
Cows w r'-h� crPe �c Gi�iPJ rl pa -i ail aPaJ woe t7 a -ll'(ed- wh fit d l v) y,O , 4
COf(ed-iVea(+vl nvasmalled- a) lllogto.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1Q- 3 3-V0 L06r)
Date: -f !b 0
.01
2/4/2011

_W
v" C
Facility No. Farm Name
V006 �Q
1'
Date f b_
Permit. COC
OIC i
Lagoon #
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
• •
un`.irwllu, l'llluwr�
aha ' r►' !-yet': �InRMMliRIM1, WSOMP -11M. 0gmzi1 �
KIMIA MM
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date;out-of compliance/ POA?
E��77ii: �l'r�•�-'T_r'�:�.t^�11.'!I„",��I:LY,�,'•f.+J
Calibration Date
Yi+w.KrDn -R'�a
`�
it Test Crop Yield Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed ?VQ WUP ✓ Dead box or incinerator
Lime Applied r 1000- Weekly Freeboard Mortality Records
Cu -I ✓ Zn -I ✓ f1 1 in Inspections Check Lists
Needs S (S-125) iVD . 1Y}a 120 min Insp. Storm Water
Needs P Vc> J Weather Codes
Rim
Waste Date
Kwirsa<wf]
(Kr,. 0
Pull]Field Soil Crop Acres PAN Window Max Rate Max Amt
-- — �+
Verify PHbNE= NUMBERS and affiliations
i Vo
FRO or Farm Records
Date last WUP at farm
Lagoon #
App. Hardware; ' ti
S�� jar
Fr
4
Stop Pump
3 �I
Clk rn'])mae-
Verify PHbNE= NUMBERS and affiliations
Date last WUP I=RO
FRO or Farm Records
Date last WUP at farm
Lagoon #
App. Hardware; ' ti
Top Dike
'
Stop Pump
Start Pump
Co version- Cu -I 3000= 108 Ib/ac, Zn -I 3000= 213 Ib/ac
Np any � lao
wa t-78 �9
"A (0a 47
c any lbo R_�
Cod a3s {ao

MS rbims 101x01(/
Type of Visit: &Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: yIJ Arrival Time: Departure Time: il',(jQ County: sQ/lEd'i
n �
Farm Name: 0 b 1(' Owner Email:
Owner Name: 01rq�. L Phone:
Mailing Address:
Physical Address:
101
Region:
Facility Contact: Wkma eopelnk -- Title: Ayol,Pl Phone:
Onsite Representative: Illfwt
ft 1LWQO 17n(3ft Integrator: % Q-
Ll�a� Y► rnli oo n,o� fh fhr��f,�� ,...
Certified Operator: Certification Number: Qg$Dyb
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes W No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes � No ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued
t
Destgnrt-urrent
Design Current
Design C«urrent
Swine
�%aa�ct Po
o
Cattle
Ca act Po P -
Wean to Finish
Layer
w
dD
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish
'"?'' r,. -
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P.oultry
Ca .act P,o ,
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes W No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes � No ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facili .y Number: $ -1 Date of Inspection: 1011
❑ Yes
allo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
RNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
[RNo
❑ NA
❑ NE
a. If yes, is waste leve] into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:_ �} P a
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
Spillway?:
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
❑ No
["NA ❑ NE
Designed Freeboard (in):_
2/4/2011 Continued
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity off any of the. structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[W No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t)_� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
['Q-No
❑ NA
[—]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
rRNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®'No
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
ff Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[$d"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W No
[DNA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below.
ff Yes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking Eq Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
❑ No
["NA ❑ NE
Page 2 of 3
2/4/2011 Continued

• Facilit Number:
Date of Inspection: (of)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes -'"" W NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[�'No
❑ NA
ONE
❑ Yes
❑ No
['NA
[] NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes allo ❑ NA ONE
❑ Yes D�No ❑ NA D NE
❑ Yes CR No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
® Yes jj�No ❑ NA ❑ NE
Comments (refeUse drawings of.facility to better explain situations (use additionaC` nes as necessary). �therTMcommepts.
(refer to question# ): Explain any YES answers and/or any additional recommendations or -any o
ll P&N Kill bp, QdA Con(/-� 00 6 �6[' �� rn c��,d_j aid- ba% i � ��
Pfvie,l Some 9rod& has h>°&� 40vP,
0[C -(b(m A [fed o c (.r� ilsfchn-01,
1Ir I- IPH7 - MyY`e10L Colmock cvl - � "Ng maiW'I Irlcallr�.
a Nodra�"h�l�� �r�ow►, fir aw�,�d [ald, Nm -f -s�r� a �a���g�la��
3�j . (�rnru p c►1�di o,) w cre+e_ wk m fd — Noae,n b�er,
G �d wl cS�lCj�l N'►'i b � �d C4/!�r �0 �� G I/�`l�'1 n'eGY' ��� '
o ood .r& , (ms)
cl6-rfirw°' 8� � c > > 7 r`s se c rfld er 7,
a
ate- Ned p1+1ss cl�efd wta6ovfofcea ears�"Plod�rt'�. � >y
lana i ti
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
a Sch neipf
Phone: [phone]
Date: 64 iii a011___
2/4/2011

Facility No.?a-5�a Farm Name WbObO P19 DateL71 1
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Desi n Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA? ,
01 's. .
Soil Test Date r
Crop Yield
• Size
Design Flow (gpmF�A =9
Wettable Acres ✓
Design Diam- (ft)
Lime Needed -7*_ ff
Soil Test Date r
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres ✓
RAIN GAUGE
Lime Needed -7*_ ff
WUP
Dead box or incinerator
_
Lime Applied
Weekly Freeboard
Mortality Records
Cu -I ✓ Zn -I ✓
1 in Inspections �_
Check Lists
Needs S (S-125)
120 min Insp.
Storm Water
Needs P
Weather. Codes
34th
Verify PHONE NUMBf R$ and affiliations so
Date last WUP FRO' (g(09 FRO or Farm Records
Date last WUP at farm Lagoon # I a
ardware Top Dike Sa �)
0�$0 p QC4
lk' 9 Stop Pump 4s pis
�.{fo -1 v o 55 St rt Pump 5°�— yq'�
X80 S COxv�i� �tslle� l �5) �L+f kap
Conversion- Cu -I 3000= 108 lb/ac- Zn -I 3000= 213 lb/ac
.. ,.
Two,
EMM
I
rx
(i
�►.�. 4 ! Y, If i
r
1a It
34th
Verify PHONE NUMBf R$ and affiliations so
Date last WUP FRO' (g(09 FRO or Farm Records
Date last WUP at farm Lagoon # I a
ardware Top Dike Sa �)
0�$0 p QC4
lk' 9 Stop Pump 4s pis
�.{fo -1 v o 55 St rt Pump 5°�— yq'�
X80 S COxv�i� �tslle� l �5) �L+f kap
Conversion- Cu -I 3000= 108 lb/ac- Zn -I 3000= 213 lb/ac

p�, Y rave I J
lap SGSi f�
4y
7
111
'�l
sem
back
,;,(o 115
In'llmo,

Type of Visit Getompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q'FZo­utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: X06 /Q Arrivsl 7Tiime: 2; Departure Time: ;BBN County:
Kon,b4. .Uu/!�'
Farm Name: �1 �lvG � Owner Email:
Owner Name: GQ a- Phone:
Mailing Address:
Physical Address:
Region., 111:7-49
Facility Contact: lVf YM44, Kjo a 41V Title: NGcJ fa- Phone No: 7OV - 064-z
Onsite Representative:�.tJi /,y1Q. �e -092w'k Aj Integrator: Pew N
Certified Operator: Ltd ^ a- eunOP144rAl Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=I
=Is Longitude: =10=1 = u
-Design Current
IRWIN
Design Current
Design Current
Swine
acity Population
Cattle C►apaeity Population
❑ Wean to Finish
❑ Layer
40
❑ Wean to Feeder I
ILI Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to WeanDry
Poultry
❑ D Cow
❑ Farrow to Feeder
_
❑ Non -Dairy
rs
ElLae❑
Farrow to Finish
El Beef Stocker
❑Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
_: _-
❑ Turkeys
Other
❑ Turkey Pouits
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 ❑ NA ❑ NE
❑ Yes ❑ No ,� ENA ❑ NE
El Yes [IId
No < ❑ NE
❑ Yes ❑ No 31A L❑ NE
❑ Yes No NA EINE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 2 —S�la
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes BNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes I—vo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:ALEJ _ 4�P:;_>
Spillway?: NO A10
Designed Freeboard (in): h W14
Observed Freeboard (in): 3O �r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes allo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
El Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need Cl Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<01 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) Cl ar S -e �r lewwai�
13. Soil type(s) AAX
14. Do the receiving crops differ from those designated in the CAWMP?
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Z'No ❑ NA ❑ NE
�To ❑ NA ❑ NE
2r No ❑ NA ❑ NE
2'N"o ❑ NA ❑ NE
E o [:1 NA 0 N
:_.. * � ., „: n ,.: _� Via:
Comments (refer to question #): Explatn;anyyVES'answe s and/or_any`recommeadations or arty other comments.
:.
facility p .s tuattans .(dse additional pages as necessary);
Use-drawingsof facili to better ex latn st
�:°
AL
T
Reviewer/inspector name ;✓ `y Phone: 910. $133-330 0
Reviewer/Inspector Signature: Date: 06, — Z0/o
12128104 Continued

Facility Number: FZ --5-561 Date of Inspection 0— /O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists
❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes 9<. ❑ NA ❑ NE
❑ Yes E'"No ❑ NA ❑ NE
❑ Yes [9- o ❑ NA ❑ NE
Other Issues
28.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
a6e
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑/Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3<o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNoo El NA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,,._,
Lb'No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
94o ❑ NA
❑ NE
�, /
31.
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Jo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a6e
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,�
Ell o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�, /
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
L9'No
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
�E]
❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
zo�
NA
NE
33.
Does facility require a follow-up visit by same agency?
E]Yes
NA
❑ NE
y� •bn �5 Y �T.✓
AgAiVt zonal Cunni tis and/or'Drawin s
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit ffCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 11110?19971 Arrival Time: /l<I �40,¢.�. Departure Time: County: _u`L`R3'/✓ _ Region: I�IZa
Farm Name: 1<0e3 pma.-i 2)4ir LLC Owner Email:
Owner Name: KoQjQiyt ¢ -j �ti r 4 , LLC, Phone:
Mailing Address:
Physical Address:
Facility Contact: W t l IM a- koop marl Title: O_T tc Z t.1Jve,4"., Phone No:
Onsite Representative. Vit 1 N^ KooP 1"44,t' integrator: INdcjLuoie'_ ,V f
Certified Operator: Operator Certification Number: yq��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 ° 1= E=1 W Longitude: [� ° [� + 0 [f
Discharges & Stream Impacts
�f
Design Current
Current
esiTi.
F4.
Design Current
Swine Capacity Papulation
Wet Poultrypapulation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
Dai Cow 00 Q
Wean to Feeder
H-1
❑Non -La er
Dai Calf
Feeder to Finish
❑ Yes
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ No
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers❑
Feeder
pBoars
Pullets❑Beef
❑ Beef Brood Co
�A
❑Turke 5
2. Is there evidence of a past discharge from any part of the operation?
Other
❑ Other
❑ TurkeyPoults
❑
Number Structures:
❑ NE
Other
Of
Discharges & Stream Impacts
�f
1. Is any discharge observed from any part of the operation'?
❑ Yes
1( No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
RNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(3<A A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
�A
[INE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�❑,
i�'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ETNo
❑ NA
❑ NE
other than from a discharge?
12/78/04
Continued

Facility Number: SZ S5�
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: —/ Aho `2—
Spillway?: 14,0/lisp
❑ Yes LI No
❑ YeseNNo
Structure 5
❑ NA ❑ NE
[INA El NE
Structure 6
Designed Freeboard (in): 90$ d(JAP
Observed Freeboard (in): .32 ~ 60
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETINo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ElYes 2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes Q'NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
Comments (refer toqueshon #13: Explain any YES answers and/or anv recomrteendations vraoy other comments.
Use drawings of facth.3 to better explain situations (use a'ddrbonal pages as necessary)
-�,
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
El Application Outside of Area
7 ccl:r':'rz
12.
Crop type(s) L�or,^j 5 n 1 t'. S .li G r`ii S 4
/
L .3 ki/ ? -S",,' AmN I.S
13.
Soil type(s) c� l.�•) �L
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l"No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
L'1No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination `? ❑ Yes
2--N'. ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Noo El NA
L��,
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,
Ed 110 ❑ NA
❑ NE
Comments (refer toqueshon #13: Explain any YES answers and/or anv recomrteendations vraoy other comments.
Use drawings of facth.3 to better explain situations (use a'ddrbonal pages as necessary)
-�,
Fcirpwe. ✓ ��lv !G'rv�
:�3 BGG. • �e�_
7 ccl:r':'rz
�?t-r.S-•�e><�
4Z, W uf 1
Reviewer/inspector Name
R�:Ve (5
Phone: 9/0. 16.33,3300
Reviewer/Inspector Signature: ��.
P.•.e.ct�
Date: of
12128104 Continued

Facility Number: 6?2 — SS(.. late of Inspection
Required Records & Documents _�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElL( Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N/o
❑ NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,�
L'1 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
io
[:1NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Na
0<
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No '❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
12/28/04

dw
7-r;- a f_n0-n4 !Z/L - -
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lz' 0 p Arrival Time: Departure Time: County: -v Region:.
Farm Name: _e_L Owner Email:
Owner Name: Ko G Z a^i g o . j)ct;y _ Phone.
Mailing Address:
Physical Address:
Facility Contact: VRAJ1"' �" Title: rdL1r&— U< V • Phone No:
Onsite Representative: ,S t u ��,t�at�' _ Integrator: ���✓"
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ED 0= 1 ET
Longitude: =0=1 = u
Desegn CurrentDestgn
Current
BNo
Design Current
, �w CapacityQnpulat'on
WetPoultry Capacity Population
Cattle
Capacity Popuiatian
n to Finish
❑ La er
❑ Yes
Dai Cow
900
❑ NE
n to Feeder
❑Non -La er
❑ No
❑ Dai Calf
❑ NE
er to Finish'
❑ DaiHeifer
ow to Wean
'''� LL
D•ow
❑ D Cow
❑ No
pjan
to Feeder
"" u�:.La
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
to Finish
ersNon-Dairyow
❑ Beef Stocker
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Non -La ersPullets
Beef Feeder
❑ NE
s
❑ Beef Brood CoTurke
s
12128/04
Continued
❑ Turke Poultsr
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
BNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
2<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
3'5A
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
Q' TA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
DIG—
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2,97
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

Facility Number: 72
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
identifier: ill) f _ 14P2
Spillway?: b do
Designed Freeboard (in):
Observed Freeboard (in): _ 34 20
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [rlo ❑ NA ❑ NE
❑ Yes Q'tvo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes B< ❑ NA ❑ NE
El Yes B o[] El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes D o' ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 0<o_ ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [l"lgo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0-ilo- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Co3r,.>i (5►la,c� �wta{� Gr",.► (Sfla T i-wj'i Sk•..+�•.►. �,.•�vu�
13. Soil type(s) iLle 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 8 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 3< ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 13 <0 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Ep o ❑ NA EINE
5,;
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: '710.533.3330
Date: /2 -!O -2006
12/28/04 Continued

Facility Number: Date of inspection W-10-0161
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps [I Other
❑ Yes
EJ No
❑ NA
❑ NE
❑ Yes
E] No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections [:1
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[:1 Yes
o
❑ NA
[INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElE Yes
,B1
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E31 o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2To
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B<o
❑ NA
❑ NE
Other Issues ��
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:1 Yes 2 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,,��
2 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
//
ca<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,//
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
13<0
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ON"O
❑ NA
❑ NE
Ad tonal Comments and/or Dr„aw ngs• r t -`� m y:
.:,�.�
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

r_j
O //.a X/zdOg
Division of Water Quality
Facility Number 92 S$� Q Division of Soil and Water Conservation
O Other Agency
j
Type of Visit ® Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: VZ -21-07 1 Arrival Time: Departure Time: •r% County: Region: /WV
Farm Name: t4 r Oki vl Owner Email:
Owner Name: e.Lauf r `NtRrD_ r S XNG.• Phone:
Mailing Address:
Physical Address:
Facility Contact: ELt J4, CAIge^1 Title: Phone No: 990,. �y0�
Onsite Representative:
Certified Operator: 344A6 Cly O�_
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =I=" Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle
Dai Cow 00
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
0 Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: L
b. Did the discharge reach waters of the State? (if ves, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes 16No ❑NA 0 N
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes
Pj No
❑ NA
❑ NE
❑ Yes
jo No
❑ NA
❑ NE
❑ Yes
[$No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection /2' - 07
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Waste Collection & Treatment
❑ NA
&No
17. Does the facility lack adequate acreage for land application? ❑ Yes
Vj No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
V No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
S
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): e �0 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
tO No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 21 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [RfNo ❑ NA ❑ NE
maintenance/improvemcnt?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � l L 1i, r..f' S w+� l G►-�t,� S Sm ke4'y- _ �^J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [6 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Vj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/inspector Name C� ; G [ �tv�f s Phone: 4I0, y33. 3300
Reviewer/Inspector Signature: u — Date: /Z---71-Z.00T
12128104 Continued

Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 21 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[INo
❑ NA
❑ NE
26 Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
❑ NA
EINE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
34. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[j] No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

R
r
Division of Water Quality
====aci1it,yNum1xerj11gZ� j s� 2 Division of soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Z'ZnS O(oArrival Time: �2; 3© Departure Time: Qj. Od County: S'OJW ao / Region: Fwo
jr
Farm Name:
I"1 f T_ r ba ��ti Owner Email:
_._. _.......
I v� r'l
Owner Name:. A r,v �+Bu �T l� � �� tis Phone: EAV33 (�1) 3ff3--
Mailing Address:
Physical Address: r
Facility Contact: S�wc i-4 (I I e lit c rtr Title: OL �—
Phone No: P/01) �1170 "e164 /
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude: °
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ NA
❑ Wean to Finish
❑ La er
Dairy Cow 4,00 O
❑ Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
ElNA
❑ Dai Heifer
Farrow to Wean
Dry Poultry
❑ Cow
Farrow to Feeder
[[0
EINE
❑ Non -Dairy
Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -Layers
Ll Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Cowl❑
2. Is there evidence of a past discharge from any part of the operation?
Turke s
W No
ther
❑ Other
❑ Turkey Poults
❑
Number of Structures:
❑ Yes
Other
❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
11 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
EVNo
ElNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
tY No
❑ NA
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
f4 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(9 No
❑ NA
EINE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
Facility Number: Date of Inspection /Z -2~S -0(n
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
[id No
ff
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
V9 No ❑ NA ❑ NE
StructurA) StructureV Structure 3 Structure 4 Structure 5
Structure 6
Identifier:Spillway?:
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Elio
Designed Freeboard (in):
❑ NE
Observed Freeboard (in): 20 Z `t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
(2rNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1FNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
UNo ❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[iVNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsideof Area
12. Crop type(s) Carty 4J LL" k Sw_, (1 6'a—S. St7 4 Id "o A/S
';-I Cl. Al
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[id No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑' No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Elio
❑ NA
❑ NE
Comments (refer to question #f): Explain any YES answers and/or�any4recommendations orany othomments. �I
Use drawings of facility to_better explain situations. (use addtttonal pagesFas"necessary):,
- s
AL
Reviewer/inspector Name FR1` ��ve-fS Phone: g101) �133 –333
Reviewer/InspectorSiguature: e.-,.. Date: G
Page 2 of 3 `" 12/28/04 Continued

Facility Number: g,z — Ssb Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [15 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [j Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[?I No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
()I No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
129 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Coin is aadloir Diriiwiq s: �
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Fallow up O Referral O Emergency 0 Other ❑ Denied Access
i
6>
Date of Visit: is 6 Arrival Time: Departure Time: LLl� County: Region: O
Farm Name: AJ ac=4 _ f:;;rcM Owner Email:
Owner Name: gU+c.� t '4gs:� _T"' _ _ Phone: 3$ 6 — H �yI,S 1&'I
Mailing Address:
Physical Address:
Facility Contact: A -Gz &= l J SL&),ami, Title: Phone No: l 3 (SY�
Onsite Representative: Tutegrator: 1A
Certified Operator: S M vT�e...w4w...� Operator Certification Number: Dtartt��5
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = [ ❑ u Longitude: =0=4
°=4 0
46
i§ ^`fix v.. z"3e "'- ry'�� ik�3�� " ;�''►+'�"r-' ' +'"- �� �rsf ii
Design. Current ` _ Design}� rCunrent Design Current
Swine��Ca aci �Po ulation R'etoul ��.
p „ ty p wtry�Capa'city Papulation CattleCapacity Population
❑ Wean to Finish Layer Dairy Cow K
❑ Wean to Feeder ❑ Non -Layer ❑ Dai Calf
❑ Feeder to Finish4 T . "- K; ❑ Dai Heifer
❑ Farrow to Wean D Pout ❑ D Cow
❑Farrow to Feeder`'` ��' - "" *k'
❑ Layers ❑ Non -Dairy
❑ Farrow to Finish ❑Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets El Beef Feeder
❑ Boars ❑Beef Brood Co
- LITurke s x :`
r
Other,, h ❑ TurkeyPoults
F11 Other
❑Other Number of Structures'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
)&No
❑ NA
❑ NE
Discharge originated av ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
CK NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
PYNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
%NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
MNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Facility Number: 97 - sSPo Date of Inspection a
§�No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No N] NA ❑ NE
Structure 1 Structurreej2 _ Structure 3 Structure 4
Structure
5 Structure 6
Identifier:[ L..
❑ NA
❑ NE
Spillway?:
❑ Yes
® No
Designed Freeboard (in):
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JQ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
I3 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yesR
No El NA El NE
maintenance or improvement?
/
Waste Application
14. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P5No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
§�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name 4 t ` , w Phone: `ilo'y1s6 X15 y/
Reviewer/Inspector Signature: Date:
12128/04 Continued

I.Evacility Number: S-- Ssro Date of Inspection i O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components o MP readily available? If yes, check ❑ Yes KNo [:1 NA El NE
the appropirate box.
ElWUaF�
CAW
MP
esign ❑ Map Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ./ ❑ Yes KNo [:1 NA [:1 NE
❑ Waste Application/ ❑ Weekly Freeboar8' ❑ Waste Analysit/❑ Soil Analysi3' ❑ Waste Transfers El Annual Certification
El Rainfall/ ❑ Stockin#/❑ Crop Yield --o 120 Minute Inspectiow_ ❑ Monthly and 1 " Rain Inspectiotf<� ❑ Weather Cock/
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
EINE
❑ Yes
❑ No
$,NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
[INA
❑ NE
❑ Yes [6No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No aNA ❑ NE
❑ Yes 2,No ❑ NA ❑ NE
[:]Yes ®No ❑ NA ❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
❑ Yes
USNo
❑ NA
❑ NE
is andlor.Drawings.. m r tp_
Additional Gommen' _ �;�-, '� �
+ ,p
ze : G�-Gir: u.j/ Gevy..i-y '� C�vf [�d~vn f�e5i0 ra.s C IVF
alb(
Z, . G"
2-0 . Gf� +,v bok" �-� {.�,., cz Jae u Q,i� Kia �asie_ Plate
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12128/04

0
`Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
(Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: Tune: 1 % 3 0
L0 Not Operational 0 Below Threshoid
B'Permitted El -Certified © Conditionally Certified © Regitered Date bast Operated or Above Threshold: _.
Farm Name: 82C4 &adFkr _ ._ County ..,. S sc! -td . » F� b
Owner Name: ......_.__L_1 a T.e.)d Ale Phone No: 710-
Malting
1o-Mailing Address: S4 Hoer �e ..- --C l �,. � rPaa� j n/ c ? 3
Facility Contact: _ Title: Phone No:
Onsite Representative: - Integrator:
Certified Operator.
Location of Farm:
Operator Certification Number.
❑ Swine ❑ Poultry ❑fattle ❑ horse Latitude ' Du Longitude • 0"
Uischac^aes & Stream
1. Is any discharge observed from any part of the operation? ❑ Yes awo
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [I No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in gaurnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ____L_
I► h
Precboard (inches): C 38
12112M3 Continued

Facility Number: -- s
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or [] Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes j] No
8. Does any part of the waste management system other than waste structures require rnaintenancclimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste ApRlrgtion
10_ Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor hisms
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below 0 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structrnwe, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
11
a/'l+q iS '10
¢ i� opt�aoy DWGT S�ae� U,.x �r.� f�r�..t �►�- *o C �re �(
`��ee bo�r�1 levels,
Reviewer/Inspector Name
��..�I�:�
ReviewerAUmpector Signature: Date:
12112103 Continued